Carbamazepine with Ticlopidine Interaction Details
Brand Names Associated with Carbamazepine
- Carbamazepine
- Carbatrol®
- Epitol®
- Equetro®
- Tegretol®
- Tegretol®-XR
- Teril®
Brand Names Associated with Ticlopidine
- Ticlid®
- Ticlopidine
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 25, 2023
Interaction Effect
An increased risk of carbamazepine toxicity (ataxia, nystagmus, diplopia, headache, vomiting, apnea, seizures, coma)
Interaction Summary
Carbamazepine toxicity developed in a patient one week after ticlopidine therapy was initiated. Metabolism of carbamazepine is mediated through the cytochrome P450 3A4 enzyme system, and ticlopidine appears to be an inhibitor of this pathway.
Severity
Moderate
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Monitor patients for signs of carbamazepine toxicity if ticlopidine is added to their therapeutic regimen. A carbamazepine plasma level may be useful if toxicity is suspected and downward dosing adjustments may be necessary. The carbamazepine dose may need to be increased when ticlopidine is discontinued.
Mechanism Of Interaction
Inhibition of cytochrome P450-mediated carbamazepine metabolism by ticlopidine
Literature Reports
A) A 67-year-old male scheduled to undergo elective coronary stenting was started on ticlopidine 250 mg twice daily one week prior to the procedure. Other medications included aspirin , diltiazem 180 mg daily, a nitroglycerin patch, and carbamazepine 600 mg twice daily. Shortly after ticlopidine therapy was initiated, the patient experienced dizziness and ataxia that resulted in his inability to walk. These symptoms would resolve five to six hours after his ticlopidine dose. Although the patient's carbamazepine level had been 43 mol/L (therapeutic range 25 to 50 mol/L) five weeks earlier, his carbamazepine was 75 mol/L on admission to the hospital. The carbamazepine dose was decreased to 500 mg twice daily and his symptoms resolved. One week after the dose decrease, the carbamazepine level was 53 mol/L. Two weeks after the discontinuation of ticlopidine, the carbamazepine level had fallen to 42 mol/L .
Carbamazepine Overview
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Carbamazepine is used alone or in combination with other medications to control certain types of seizures in people with epilepsy. It is also used to treat trigeminal neuralgia (a condition that causes facial nerve pain). Carbamazepine extended-release capsules (Equetro brand only) are also used to treat episodes of mania (frenzied, abnormally excited or irritated mood) or mixed episodes (symptoms of mania and depression that happen at the same time) in patients with bipolar I disorder (manic-depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). Carbamazepine is in a class of medications called anticonvulsants. It works by reducing abnormal electrical activity in the brain.
Ticlopidine Overview
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Ticlopidine is used to reduce the risk of stroke in people who have had a stroke or have had warning signs of a stroke and who cannot be treated with aspirin. Ticlopidine is also used along with aspirin to prevent blood clots from forming in coronary stents (metal tubes surgically placed in clogged blood vessels to improve blood flow). It works by preventing platelets (a type of blood cell) from collecting and forming clots.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.